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AJNR - American Journal of Neuroradiology

Published ahead of print on October 10, 2007
doi: 10.3174/ajnr.A0769

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Coinfection of Japanese Encephalitis with Neurocysticercosis: An Imaging Study

S.K. Handique^a, R.R. Das^b, B. Saharia^a, P. Das^a, R. Buragohain^a and P. Saikia^c

^a Departments of Radiology and Imaging, Institute of Neurological Sciences, Dispur, Assam, India
^b Department of Neurology, Institute of Neurological Sciences, Dispur, Assam, India
^c Department of Microbiology, Institute of Neurological Sciences, Dispur, Assam, India

View larger version (108K): [in this window] [in a new window]   Fig 1. Thirty-one-year-old man with coinfection of JE and NCC (patient no. 2). A and B, Contrast-enhanced CT scans show nonenhancing left thalamic lesion (arrow in A) with a left parietal cysticercus with identifiable scolex and edema (arrow in B). C and D, Axial T2-weighted MR imaging scans done on day 4 of onset of symptoms show a left parietal cysticercus with edema (arrow in C) and T2 hyperintense bilateral thalamic lesions, with predominant lesion on the left side (arrows in D). E, Follow-up axial T2-weighted MR imaging done after 67 days from onset shows resolution of the thalamic lesions.

View larger version (116K): [in this window] [in a new window]   Fig 2. Twelve-year-old girl with coinfection of JE and NCC (patient 5). A, Axial T2-weighted MR imaging done on day 5 after onset of symptoms shows a left frontal cysticercus with T2 hyperintense perifocal edema (arrow). This lesion showed ring enhancement with edema on contrast enhanced CT (not shown). B, Axial T2-weighted MR imaging done on the same day as A shows a left thalamic lesion with mass effect (arrow). The substantia nigra were not involved in this stage (not shown). C and D, Axial T2-weighted MR imaging scans done on day 13 show involvement of both thalami (arrows in C) and both substantia nigra (arrows in D). E, Axial T2-weighted MR imaging done after 45 days of onset shows residual lesions in both substantia nigra (arrows). Residual lesions were also seen in both thalami at this stage (not shown).

View larger version (63K): [in this window] [in a new window]   Fig 3. Thirteen-year-old girl with coinfection of JE and NCC (patient 6). A, Axial T2-weighted MR imaging scan showing a left basal ganglia granulonodular NCC with edema (arrow). B, Axial T2-weighted scan done at the same time as A shows bilateral thalamic involvement, more on the left side (arrows). Note sparing of the basal ganglia in the vicinity of the cyst. C, Axial T2-weighted scan slightly lower than B shows bilateral substantia nigra, left more than right (arrows) and left midbrain tectum (double arrows).

View larger version (107K): [in this window] [in a new window]   Fig 4. Fifty-eight-year-old woman with JE without NCC showing asymmetric lesions. A, Axial T2-weighted MR imaging done on day 3 of onset shows thalamic lesion on the right (double arrows). Note bilateral hippocampal tail involvement (single arrows). B, Axial T2-weighted MR imaging done on same day as A shows right sided substantia nigra (black arrow) and the hippocampal lesions (white arrows). This patient is patient 2 of our previous publication.4